Fever and Rash: Revisiting Measles.

Fever and rash are a common combination of symptoms in the young adult patient. The etiologic investigation is usually oriented towards the most common diseases, but atypical presentations of less frequent conditions should also be recalled. We describe the case of a 44 year-old Portuguese woman who presented with fever, conjunctivitis, cough and rash, rapidly evolving to hepatitis and extensive pneumonia with respiratory failure. Although she claimed to be vaccinated according to the national immunisation schedule, a final diagnosis of primary measles pneumonia was clinically made and confirmed by serology. However, some less typical features mislead us initially. Although the rare form of primary measles pneumonia is more prevalent among immunosuppressed patients, our patient was immunocompetent. Moreover, absence of contagiousness, as was the case, occurs more frequently in atypical measles. This case highlights the need to always confirm the alleged vaccination status in adults and raises attention to some unusual features of typical measles.